应用ROC曲线评价颈总动脉内中膜厚度对冠心病的诊断价值

目的 :探讨冠心病 (CHD)患者颈动脉内中膜厚度 (IMT)及粥样斑块的发生情况 ,及其对CHD的诊断价值。方法 :据冠状动脉造影将 76例患者分为CHD组 (5 2例 )和非CHD组 (2 4例 ) ,分别进行颈动脉超声检查 ,应用受试者工作特征 (ROC)曲线评价颈总动脉IMT ,以冠状动脉造影作为金标准 ,计算IMT及粥样斑块诊断CHD的灵敏性、特异性。结果 :非CHD组及CHD组IMT分别为 (0 .79± 0 .11)及 (1.11± 0 .37)mm ,斑块发生率分别为 8.3% (2 / 2 4 )及 71.2 % (37/ 5 2 ) ,两组间比较均差异有统计学意义 (P <0 .0 1)。颈总动脉IMT诊断CHD的ROC曲线下面积 (AUC)为 0 .80 ,IMT诊断CHD的最佳分界值为 0 .90mm ,以IMT≥ 0 .90mm及 (或 )出现粥样斑块来预测CHD ,敏感性 82 .7% ,特异性 79.2 %。结论 :颈总动脉IMT对诊断CHD有一定的准确性 ,IMT≥ 0 .90mm及 (或 )出现粥样斑块是预测CHD较为敏感的指标。     

腺苷负荷超声心动图诊断冠心病的临床评价

目的:以冠状动脉造影(CAG)为金标准,评价腺苷负荷超声心动图(ASE)试验诊断冠心病(CHD)的敏感性和特异性.方法:40例临床疑诊CHD患者,分别静脉注射腺苷(140 μg·kg-1·min-1)6 min(总剂量为0.8 mg/kg).出现节段性室壁运动异常为阳性.所有患者1周内行CAG检查.结果:ASE诊断CHD的敏感性为82.6%,特异性为88.2%,准确性为85.0%;诊断单支、双支和3支冠状动脉病变的敏感性分别为75.0%,85.7%,100%,且不良反应少.结论: ASE诊断CHD安全可靠.     

核素心肌灌注显像与电子束CT诊断冠心病的对比研究

目的 :比较核素心肌灌注显像 (SPECT)与电子束 CT(EBCT)冠状动脉钙化定量积分对冠心病 (CHD)的诊断价值。方法 :44例住院患者同时进行冠状动脉造影 (CAG)、SPECT和EBCT检查。以 CAG为金标准 ,比较 SPECT与 EBCT诊断 CHD的各项诊断指标 ,并评价平行试验和系列试验的诊断指标。结果 :SPECT诊断 CHD的敏感性为 88.9% ,特异性为 69.2 % ,准确性为 77.3% ;EBCT以钙化积分≥ 1 0分为阳性标准 ,敏感性、特异性、准确性分别为 77.8%、80 .8%及 79.5%。这两种方法对检测 CHD的价值相似 (P >0 .0 5)。 SPECT与 EBCT联合平行试验的准确性为 72 .7% ;系列试验的准确性为 86.4%。结论 :SPECT与 EBCT诊断 CHD的效率相近 ;SPECT显像和 EBCT冠状动脉钙化定量积分法均为非创伤性检查法 ,对 CHD的诊断各有优势 ,宜结合使用     

血清甘油三酯代谢与冠状动脉病变的相关分析

目的 :分析冠心病 ( CHD)患者血清甘油三酯 ( TG)水平与冠状动脉病变的关系 ,探讨 TG在 CHD发生、发展中的作用。方法 :CHD患者 30 2例 ( CHD组 ) ,年龄 35～ 74岁 ,均经冠状动脉造影证实至少一支冠状动脉狭窄 >5 0 % ,其中单支病变 196例 ,双支病变 5 1例 ,3支病变 35例 ,左主干病变 2 0例。对照组 315例 ,年龄 2 6～ 6 4岁 ,为健康体检者。所有受检者检查前一天晚餐禁食高脂肪饮食及禁酒 ,次日晨 7:0 0～ 8:0 0采静脉血 2 ml测TG。以 TG>1.7m mol/ L为高 TG血症标准。结果 :CHD组、对照组血清 TG水平分别为 ( 1.7± 0 .6 ) mm ol/ L、( 1.4± 0 .5 ) mm ol/ L ,差异非常显著 ( P <0 .0 0 1) ;CHD组高 TG者比率为 33.4% ,对照组为 9.8% ,两者差异非常显著 ( P <0 .0 0 1)。 CHD组高 TG者双支、3支及左主干冠状动脉病变占 47.5 % ,正常 TG者为 2 8.9% ( P <0 .0 0 1) ,提示高 TG者冠状动脉病变相对较重。结论 :血清 TG水平与 CHD关系密切 ,对 CHD患者异常 TG的干预 ,应是 CHD防治策略的重要问题     

运动诱发心肌缺血对QT离散度的影响

目的通过平板运动试验(ETT)前后冠心病(CHD)病人与冠状动脉正常者的QT离散度(QTd)变化,研究运动引起的心肌缺血对QTd的影响。方法分析经冠状动脉造影(CAG)证实的41例CHD病人与45例CAG正常者ETT前和运动高峰时体表十二导联心电图QTd变化。结果运动前、运动高峰CHD组QTd分别为(47.84±11.19)ms、(62.16±10.45)ms(P0.01);而CAG正常者分别为(24.22±15.15)ms、(23.11±14.43)ms(P0.05)。以运动中QT≥50ms判为异常,诊断CHD的敏感性为86.2%,特异性88.9%,预测准确性87.5%。结论运动高峰较大的QTd有助于反映冠状动脉病变及心肌缺血程度。并提示QTd是ETT中诊断CHD心肌缺血敏感而特异的指标。     

99mTc-MIBI运动后早期门控心肌显像诊断冠心病的价值

目的:比较99mTc-MIBI门控心肌显像(G-MPI)与传统的非门控心肌显像(NG-MPI)对冠心病(CHD)的诊断价值。方法:215例同期1个月内做负荷(运动后15~20min)/静息2日法99mTc-MIBIG-MPI和冠状动脉造影的CHD患者,以冠状动脉直径狭窄≥50%为诊断标准,比较NG-MPI和G-MPI的诊断价值。结果:心电图运动试验(ETT)、NG-MPI和G-MPI诊断CHD的敏感性分别为:58.0%,88.3%,90.7%;特异性分别为:67.9%,79.2%,88.7%。NG-MPI和G-MPI的敏感性与ETT相比均差异有统计学意义(P<0·01)。G-MPI的诊断敏感性比NG-MPI有增高趋势,但两者比较差异无统计学意义(P>0·05)。在诊断特异性方面,G-MPI与ETT相比差异有统计学意义(P<0·01);对男、女2个性别的特异性分析发现,G-MPI对女性诊断特异性的增加尤其显著。对于严重CHD(狭窄≥70%),G-MPI对严重3支病变的诊断敏感性显著高于NG-MPI(100%∶92·2%,P<0·05)。结论:G-MPI对诊断CHD的价值显著优越于ETT,也优于NG-MPI。     

甘油三酯/高密度脂蛋白胆固醇比值对老年冠心病诊断价值的探讨

目的 :探讨甘油三酯 /高密度脂蛋白胆固醇 (TG/ HDL- C)比值对老年冠心病 (CHD)的诊断价值。方法 :分析 34 2例选择性冠状动脉造影 (冠脉造影 )确诊的老年 CHD患者 (CHD组 )及 96例冠脉造影阴性老年人 (对照组 )的 TG/ HDL - C比值水平与 CHD之间的关系。结果 :CHD组患者的 TG/ HDL - C比值水平及异常率均明显高于对照组 (2 .5 4± 1.2 9比 1.32± 1.16 ,P<0 .0 0 1,35 .6 %比 13.7% ,P<0 .0 0 1)。经多元逐步回归分析显示 :与 TG、HDL - C相比 ,该比值与 CHD之间显示了更有意义的回归关系 (β值 0 .32 ,P值 =0 .0 0 0 1,复相关系数为 0 .5 5 )。结论 :TG/ HDL- C比值对于老年 CHD诊断是一有临床使用价值的指标     

QTpd及QRS宽度和QRS额面电轴在冠心病患者运动试验中的意义

目的 :探讨平板运动试验中冠心病 (CHD)患者与非CHD患者QTpd、QRS宽度和QRS额面电轴变化的意义。方法 :对 6 6例经冠状动脉造影和活动平板检查的患者 ,根据冠状动脉病变程度分为非CHD组和CHD组 ,观察运动试验前后QTpd和QRS宽度的变化 ;CHD组根据病变所累及的血管分为 3个亚组 ,CHD组 1为左前降支病变有或无左回旋支病变 ,CHD组 2为右冠病变有或无左回旋支病变 ,CHD组 3为 3支病变或左前降支病变有或无右冠病变 ,观察运动试验前后QRS额面电轴的改变。结果 :①运动前CHD组与非CHD组QTpd、QRS宽度差异无显著性意义 (P >0 .0 5 )。②运动后非CHD组QTpd无明显改变 (P >0 .0 5 )、QRS宽度变窄 (P <0 .0 1) ,CHD组QTpd增大、QRS宽度延长 (P <0 .0 1)。③运动后 ,非CHD组QRS额面电轴无明显改变 (P >0 .0 5 ) ,CHD组 1QRS额面电轴向左偏 (P <0 .0 1) ,CHD组 2QRS额面电轴向右偏 (P <0 .0 1) ,CHD组 3QRS额面电轴改变无统计学意义 (P >0 .0 5 )。结论 :运动导致的QTpd增大、QRS时限延长及QRS额面电轴的改变对CHD及其所累及的血管的定位诊断有较大的意义     

女性踏车运动试验中QTc延长的意义

目的 :探讨女性踏车运动试验前后校正QT间期的变化及意义。方法 :分析 14 5例行冠状动脉 (冠脉 )造影检查的女性患者亚极量踏车运动试验前后QTc的动态变化 ,计算以运动后即刻QTc较运动前QTc延长≥ 4 0ms作为运动试验阳性判断标准的临床价值 ,并与传统ST下移标准的临床价值进行对照。结果 :冠心病(CHD)组运动后即刻QTc与运动前QTc的差值 (即刻ΔQTc)较非CHD组显著增大 ,且随冠脉狭窄程度的加重而增大 ;以运动后即刻ΔQTc≥ 4 0ms作为运动试验阳性的判断标准 ,其特异性、敏感性、准确性分别为 90 .0 % (P<0 .0 5 )、88.7% (P <0 .0 1)、89.0 % (P <0 .0 1) ,显著优于传统的ST标准。结论 :女性CHD患者运动试验后QTc显著延长 ,运动后即刻ΔQTc≥ 4 0ms可作为女性运动试验阳性的判断标准 ,它有利于克服运动试验中ST标准对女性CHD患者误诊率高、假阳性率高的缺点     

冠心病患者及高危人群血脂异常分析

目的 :观察甘肃地区冠心病 (CHD)和高危人群的低密度脂蛋白胆固醇 (LDL C)的异常情况。方法 :分析 2 2 0例冠状动脉造影 (CAG)确诊的CHD者 (CHD组 )及 90例富含CHD危险因素、CAG阴性的非CHD者(NCHD组 )的总胆固醇 (TC) ,三酰甘油 (TG) ,LDL C ,高密度脂蛋白胆固醇 (HDL C)水平及异常率。结果 :与NCHD组相比 ,CHD组的平均TC和LDL C水平明显增高 ,HDL C水平降低 (P <0 .0 5 )。CHD组LDL C和HDL C异常率明显大于NCHD组 ,分别为 6 8.6 % :4 6 .7%和 5 0 % :2 6 .7% (均P <0 .0 1)。CHD组患者LDL C水平的达标率为 33%左右。结论 :LDL C水平升高和HDL C水平降低是该地区CHD发生和发展的关键。CHD及其高危人群中他汀类药物的应用应加强并且有很大空间。通过药物开发提高HDL C水平在防治CHD事件将有很好的前景     

活动平板试验中收缩压恢复比对冠心病的预测价值

目的：研究活动平板试验中收缩压恢复比（rSBP）对冠心病的诊断价值。方法：99例患者接受活动平板试验和冠状动脉造影,分为冠心病组（56例,冠脉造影阳性）、高血压病组（18例,冠脉造影阴性）和对照组（25例,冠脉造影阴性）,对比分析rSBP和ST／HR斜率对冠心病的诊断价值。结果：冠心病组、高血压病组3minrSBP值[（0．94±0．09）、（0．80±0．10）]显著高于对照组的（0．74±0．06）,分别P〈0．01,〈0．05。rSBP诊断冠心病的敏感性、特异性、准确性分别为89．3％、76．7％、特异性、准确性分别为90．7％、90．3％、94．2％。结论：斜率可提高诊断的特异性和准确性。83．3％,联合rSBP和ST／HR斜率诊断冠心病的敏感性、rSBP可作为诊断冠心病的无创指标之一,联合ST／HR     

High-sensitivity C-reactive protein levels and treadmill exercise test responses in men and women without overt heart disease

BACKGROUND:

C-reactive protein (CRP) is a marker of systemic inflammatory activity and may be modulated by physical fitness. Treadmill exercise testing is used to evaluate cardiovascular health through different variables including exercise capacity, heart rate and blood pressure responses. It was hypothesized that CRP levels are associated with these variables in men and women without overt heart disease.

METHODS:

A total of 584 asymptomatic subjects (317 [54.3%] women and 267 [45.7%] men) were enrolled in the present study and underwent clinical evaluation. CRP levels in men and women were examined relative to clinical characteristics and to variables of treadmill exercise testing: peak heart rate, exercise systolic blood pressure, exercise time, chronotropic reserve and heart rate recovery at the first and second minutes after exercise. Multivariate analysis was performed using a log-linear regression model.

RESULTS:

In women, exercise time on the treadmill exercise test (P=0.009) and high-density lipoprotein cholesterol levels (P=0.002) were inversely associated with CRP levels. Body mass index (P<0.001) and total cholesterol levels (P=0.005) were positively associated with CRP levels. In men, exercise time on the treadmill exercise test was inversely associated with CRP levels (P=0.015). Body mass index (P=0.001) and leukocyte count (P=0.002) were positively associated with CRP levels. CRP levels were not associated with peak heart rate, chronotropic reserve, heart rate recovery at the first and second minutes, or exercise systolic blood pressure.

CONCLUSIONS:

These findings contribute to the evidence that CRP is lower in individuals with better exercise capacity and demonstrate that this relationship is also apparent in individuals without overt heart disease undergoing cardiovascular evaluation through the treadmill exercise test. Lowering inflammatory markers may be an additional reason to stimulate sedentary individuals with low exercise capacity in the treadmill exercise test to improve physical conditioning through regular exercise.     

收缩压恢复比对冠心病的诊断价值

为探讨活动平板运动试验中收缩压恢复比对冠心病的诊断价值 ,并从诊断敏感度、特异度、诊断符合率方面与传统的冠心病诊断指标进行对比 ,随机选择了 99例进行了活动平板运动试验与冠状动脉造影的患者 (冠状动脉造影证实 5 6例有冠心病 ,43例无冠心病 ) ,分析其收缩压恢复比与冠心病的关系。结果发现 ,收缩压恢复比 >0 .91诊断冠心病的敏感度、特异度、诊断符合率分别为 5 3 .6%、83 .7%、66.7% ,而传统指标分别为 91.1%、5 5 .8%、75 .8% ;收缩压恢复比 >0 .91在诊断冠状动脉单支、双支和多支血管病变中的敏感度逐渐增加 ,但均低于同组传统指标的诊断敏感度 ;峰值心率与静息心率呈正相关 (r=0 .44 2 ,P <0 .0 0 1) ;峰值收缩压与静息收缩压呈正相关 (r =0 .5 78,P <0 .0 0 0 1)。结果提示 ,运动试验中收缩压恢复比异常可预测冠心病 ,其诊断敏感性低于传统诊断指标 ,但特异度高于传统指标     

高敏C反应蛋白与运动试验结果的相关性

目的研究人体高敏C反应蛋白水平与平板运动试验中各变量（最高心率、运动时收缩压、运动时间、变时储备和运动后恢复心率）间是否存在某种关联。方法收集2010年到2012年我院行平板运动试验结果为阴性的体检患者,按性别分两组,分别运用多元线性回归模型进行CRP与运动试验各变量之间的相关性分析。结果两组运动时间与CRP值均呈负相关,而BMI与CRP均呈正相关。CRP水平与最高心率、运动时收缩压、变时储备和运动后恢复心率均无明显关系。结论高敏CRP在运动耐量大的个体中水平较低。     

Incidence and significance of decreases in systolic blood pressure during graded treadmill exercise testing.

The incidence of decreases in peak systolic blood pressure during treadmill exercise was investigated in 460 patients with definite or suspected coronary heart disease. All patients were studied with coronary cineangiography. Exercise was continued to one of the following end points: chest pain, 85 to 90 percent of the patient's age-predicted maximal heart rate, ventricular tachycardia or a sustained decrease of 10 mm Hg or more below the peak level of systolic blood pressure. Twenty-two patients with 75 percent or greater stenosis of one or more major coronary arteries manifested a decrease in systolic pressure 10 mm Hg or more during exercise. These included 15 (17 percent) of 88 patients with three vessel, 7 (7 percent) of 101 with two vessel and 0 of 90 with single vessel disease. The decrease in pressure was reproducible in the seven patients who underwent a second exercise test before alteration of therapy; this decrease was abolished in the six patients who exercised again after coronary bypass graft surgery.A decrease in systolic pressure of 10 mm Hg or more also occurred during exercise testing in 3 of 23 patients with noncoronary organic heart disease; all 3 had an obstructive cardlomyopathy that had not been suspected clinically. Only 1 of 158 subjects with chest pain and no demonstrable heart disease had a decrease in systolic blood pressure with exercise. Declines in blood pressure were not observed during 650 maximal exercise tests performed on 560 clinically normal men.In conclusion, if one excludes subjects with cardiomyopathy or significant heart valve disease, a sustained exercise-induced decrease in peak systolic blood pressure of 10 mm Hg or more is a highly specific sign of multiple vessel coronary artery disease. This phenomenon is best explained by acute left ventricular pump failure secondary to extensive myocardial ischemia.     

Comparison of exercise-positive with recovery-positive treadmill graded exercise tests

A treadmill exercise test response may become positive because a diagnostic electrocardiographic ST-segment shift occurred during exercise, or, less often, because it occurred only during the recovery period after exercise had been completed. Factors that may be related to these 2 different responses in subjects enrolled in the Program of Surgical Control of Hyperlipidemia were investigated. No differences were found with regard to age, sex, level or location of Minnesota electrocardiographic Q-QS codes, number of narrowed coronary arteries, presence of collateral coronary artery circulation, ejection fraction, number of abnormally moving left ventricular wall segments, heart rate, systolic and diastolic blood pressure, double product, total exercise time, exercise-induced angina, or maximally achieved exercise heart rate or double product. Thus, the same significance should be attributed to a recovery-positive as to an exercise-positive treadmill test, and electrocardiographic, hemodynamic and angiocardiographic variables do not distinguish between subjects who exhibit these 2 different responses.     

平板运动试验后心率恢复情况对冠心病的诊断价值

目的评价平板运动试验后心率恢复的意义及其对冠心病的诊断价值。方法76例拟诊冠心病患者行平板运动试验,根据冠状动脉造影结果分为冠心病组和非冠心病组。计算运动后1、2、3、4、5、7min心率恢复值并比较,利用运动后心率恢复异常作为诊断冠心病标准与传统的ST段压低法比较。结果冠心病组的患者运动后各时段心率恢复值均低于非冠心病组。以运动后1、2min心率恢复异常作为诊断冠心病的标准,与传统的ST段压低法相比,其敏感性无差别,特异性较高。结论冠心病组与非冠心病组比较表明,运动后心率恢复存在明显差异,且运动后心率恢复异常可以作为诊断冠心病的方法之一。     

Intracardiac echocardiography in monitoring atrial septal defect percutaneous closure: initial experience in an adult laboratory

The predictors for coronary artery disease (CAD) in patients with delayed systolic blood pressure (SBP) recovery after graded exercise are unclear. We studied 672 patients with preceding positive symptom-limited exercise treadmill testing (ETT) and underwent their first coronary angiography within 90 days to determine the high-risk profiles for angiographic CAD in patients with paradoxical SBP elevation (the SBP at 3-min of recovery was equal to or higher than that at 1-min of recovery). Among them, 356 patients were diagnosed as CAD, of which 173 were severe CAD. Among 208 patients with paradoxical SBP elevation, 158 (76%) were CAD, and 101 (48.6%) were severe CAD. Multivariate logistic regression analyses identified male gender and hyperlipidemia as positive predictors and maximal heart rate and exercise time as negative predictors for CAD or severe CAD. In conclusion, patients with both positive ETT for ischemia and paradoxical SBP elevation during recovery have a high prevalence of CAD and severe CAD. The high-risk patients for the presence of CAD or severe CAD were those of male, with hyperlipidemia, low achievable maximal heart rate, and short exercise time after graded exercise.     

Ventricular arrhythmias during clinical treadmill testing and prognosis

BACKGROUND: Although exercise-associated ventricular arrhythmias are frequently observed during exercise testing, their prognostic significance remains uncertain. Therefore, we aimed to evaluate the clinical correlates and prognostic significance of exercise-associated premature ventricular complexes (PVCs) during and after exercise testing. METHODS: We studied 1847 heart failure-free patients who underwent clinical treadmill testing between March 13, 1997, and January 15, 2004, in the Veterans Affairs Palo Alto Health Care System. Logistic regression was used to evaluate the clinical and exercise test associations of exercise and recovery PVCs. Propensity score-adjusted Cox survival analyses were used to evaluate the prognostic significance of exercise-associated PVCs. RESULTS: Of the 1847 subjects, 850 (46.0%) developed exercise PVCs (median rate, 0.43 per minute) and 620 (33.6%) had recovery PVCs (median rate, 0.60 per minute). Resting PVCs, age, and systolic blood pressure were key predictors of both exercise and recovery PVCs. Whereas exercise PVCs were related to the heart rate increase with exercise, recovery PVCs were related to coronary disease (previous myocardial infarction, coronary revascularization procedure, or pathological Q waves on resting electrocardiogram) and ST-segment depression. During a 5.4-year mean follow-up, 161 subjects (8.7%) died, and 53 of these deaths (32.9%) were due to cardiovascular causes. Recovery PVCs, but not exercise PVCs, were associated with 71% to 96% greater propensity-adjusted mortality rates (hazard ratio, 1.96 [95% confidence interval, 1.31-2.91] for infrequent PVCs; hazard ratio, 1.71 [95% confidence interval, 1.07-2.73] for frequent PVCs compared with subjects without PVCs), and occurrence of recovery PVCs reclassified 33.2% of subjects with intermediate-risk Duke Treadmill Scores into higher-risk subgroups. CONCLUSION: In our heart failure-free population, recovery PVCs were associated with increased mortality and augmented established risk markers.     

Delayed systolic blood pressure recovery after graded exercise: an independent correlate of angiographic coronary disease.

OBJECTIVE: This study was performed to determine whether a delayed decline in systolic blood pressure (SBP) after graded exercise is an independent correlate of angiographic coronary disease. BACKGROUND: The predictive importance of the rate of SBP decline after exercise relative to blood pressure changes during exercise has not been well explored. METHODS: Among adults who underwent symptom-limited exercise treadmill testing and who underwent coronary angiography within 90 days, a delayed decline in SBP during recovery was defined as a ratio of SBPs at 3 min of recovery to SBP at 1 min of recovery >1.0. Severe angiographic coronary artery disease was defined as left main disease, three-vessel disease or two-vessel disease with involvement of the proximal left anterior descending artery. RESULTS: There were 493 subjects eligible for analyses (age 59 +/- 11 years, 78% male). Severe angiographic coronary disease was noted in 102 (21%). There were associations noted between a delayed decline in SBP during recovery and severe angiographic coronary disease (34% vs. 17%, odds ratio [OR] 2.59, confidence interval [CI] 1.58 to 4.25, p = 0.001). In multivariate logistic regression analyses adjusting for SBP changes during exercise and other potential confounders, a delayed decline in SBP during recovery remained predictive of severe angiographic coronary disease (adjusted OR 2.22, 95% CI 1.27 to 3.87, p = 0.005). CONCLUSIONS: A delayed decline in SBP during recovery is associated with a greater likelihood of severe angiographic coronary disease even after accounting for the change in SBP during exercise.